The article entitled ‘Clinical Pulmonary Infection Score to diagnose
ventilator-associated pneumonia in children’ makes interesting reading
[1].
A variety of sampling techniques can be used to
obtain a bronchial sample for culture and it is not always necessary to
use a bronchoscopic BAL to confirm the diagnosis [2,3,4]. This assumes
greater significance in infants ventilated with smaller endotracheal
tubes (ETTs) as it is not possible to pass the bronchoscope through
these ETTs. In the study mentioned above, the authors have used an LMA
to pass the bronchoscope in such infants to obtain a BAL. Such a
procedure of replacing an ETT in a child requiring mechanical
ventilation with an LMA for a diagnostic procedure is fraught with
danger and cannot be universally recommended. In fact, the LMA is
relatively contraindicated for bronchoscopy in patients in whom
endotracheal intubation and intermittent positive pressure ventilation
offers a safer alternative [5]. The absence of complications in this
particular study cannot justify this practice.
Alternative methods of obtaining uncontaminated lower
airway samples for culture such as a mini-BAL, blind bronchoscopic
sampling and non-bronchoscopic BAL are acceptable for routine clinical
practice [3,4] and can be used safely in ventilated infants.
References
1. Sachdev A, Chugh K, Sethi M, Gupta D, Wattal C,
Menon G. Clinical pulmonary imfection score to diagnose
ventilator-associated pneumonia in children. Indian Pediatr.
2011;48:949-53.
2. Lodha R, Kabra SK. Diagnosis of ventilator
associated pneumonia: is there a simple solution. Indian Pediatr.
2011;48:939-40.
3. Venkatachalam V, Hendley JO, Willson DF. The
diagnostic dilemma of ventilator-associated pneumonia in critically ill
children. Pediatr Crit Care Med. 2011;12:286-96.
4. Foglia E, Meier MD, Elward A.
Ventilator-associated pneumonia in neonatal and pediatric intensive care
unit patients. Clin Microbiol Rev. 2007;20:409-25.
5. Slonim AD, Ognibene FD. Enhancing patient safety
for pediatric bronchoscopy. Alternatives to conscious sedation. Chest.
2001;120:341-2.